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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been really amazed at the number of people I’ve heard talking about the HITECH Act bringing in a “new age of EHR” and other similar phrases. Then, I usually consider who’s been saying it and I realize that their pocketbooks are going to be lined with money from the HITECH Act and EHR adoption. So, I take it with a grain of salt.

Instead, I like to look at examples to help me better understand what might happen with the $18 billion Obama’s planning to spend on EHR adoption. The best example I know of comes from the British National Health System. It’s certainly not a perfect match, but should open our eyes on government funded EHR systems.

Britain’s NHS, who have been trying to get their HIT system to work properly for the past 5 years. The cost of NHS’ HIT has escalated to 6 times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the USA.

HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next 6 months.

A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one.

And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors.

Definitely cause for concern since Britain has spent $18.4 billion on a MUCH smaller health care system. Looks like Obama should have applied his “down payment” principle to HITECH Act’s $18 billion towards EHR too.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my biggest fears about the carrot and stick approach to the HITECH EHR stimulus package is that many doctors are never going to see any of the EHR stimulus package. Not because they aren’t going to implement an EHR, but because they won’t meet the “meaningful use” criteria that HITECH requires.

This isn’t a view that I share alone. Take a look at the following two comments made about HITECH’s inability to actually pay the doctors who participate.

CEOMike’s (CEO of Medscribbler) take on doctor’s qualifying for the EHR stimulus:

Not only is the EMR have to qualify – THE DOCTOR IS GOING TO HAVE TO QUALIFY – the experience with e-prescribing and the incentives programs is a LOT of doctors who thought they would get money didn’t even though their EMR produced the required information – a lot of times the information produced by the EMR proved the doctor did NOT qualify !!!

Remember this is government !!!

Al Borg’s take on past projects similar to the HITECH reimbursement plan:

In past demonstration projects, less than half of physicians or practices ever got any money and those that did got much less than what they thought they would get (the most recent one the 40% which were winners won only $600 on average). Everyone that participated ended up a loser, whether they got paid or not. Are they nuts?

Certainly some people will see the money. The question is whether you’ll be one of them. It’s why I still believe that $18 billion of EHR Stimulus won’t actually be spent.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love how people are saying that $18 billion will be spent on EHR adoption due to what has been dubbed the HITECH act. My question is how did they come up with the $18 billion number? I guess you could say that it’s the max that the government has permitted to be spent. However, if that’s the case, then shouldn’t people be saying that $18 billion MIGHT be spent to stimulate EHR adoption?

Seriously, what if doctors don’t like any of the certified EHR (whatever that turns out to be) and decide not to implement an EHR? What if Medicaid and Medicare make “meaningful EMR use” so difficult to achieve that most doctors who implement an EHR don’t actual see the stimulus from the government?

I’m not trying to say that the government isn’t going to pay our billions of dollars to those who have implemented an EHR. I have a feeling that billions will be paid out as medicare and medicaid bonuses. However, I don’t know how they got the number of $18 billion. For all we know, it could end up being $2 billion.

Plus, we have to ask ourselves the purpose of the HITECH act. Many have said that it’s to “stimulate EHR adoption.” I have a strong feeling that those existing EHR users will be the ones who benefit most. If $15 billion of the $18 billion allocated goes to existing EHR users, then that doesn’t sound like a good investment used to increase EHR adoption to me.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Currently, doctors must invest time and money to implement EHR systems, but it’s the insurers and payers who ultimately benefit, thanks to a reduction in unnecessary tests and medications.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Whenever government decides to spend $20 billion, there are bound to be a lot of winners. The money has to go somewhere. I previously posted how I think that EHR adoption won’t significantly increase because of HITECH. However, there will be some BIG winners from this legislation. Lets’s take a quick look at a few of them.

EHR Vendors – I don’t think there’s any doubt that vendors will benefit from $18 billion of investment in EHR. The legislation was signed yesterday, and I’ve already seen ads for Allscripts talking about learning about the EHR stimulus. Marketers for every “certified” EHR are going to beat this stimulus like a dead horse.

Health Care IT Consultants (ohhh…maybe I should become one) – Business should be just fine for EHR and health care IT consultants despite the current economic crisis. I didn’t think there were enough before. Even a small increase in EHR adoption will mean higher demand for health care IT consultants.

Existing EHR Users – Despite my feeling that this stimulus won’t stimulate EHR adoption, I do think that already implemented EHR users should benefit from this EHR stimulus. I didn’t read any “first time home buyer” provision in this legislation. This could mean a bit of free (minus a little paperwork) cash for those who find themselves already using a certified EHR.

CCHIT (if they get chosen) – This is a big IF, but I believe that CCHIT’s survival hinges on them being chosen as the certification required to receive stimulus. It would say a lot if they weren’t chosen. Let’s hope HHS has the guts to not choose them despite the incredible lobbying efforts I’m sure they’ll receive.

Hospital Systems – I’m familiar with one hospital system that has over 100 multi specialty clinics with many of them using a centralized EHR. Seems like a great investment to pay someone to make sure they meet the required standards. 100 clinics X number of doctors in a clinic X $40k = a lot of money

Health and Human Services (HHS) – Even just the $2 billion in discretionary funding is a huge boost to that organization.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Health Information Technology for Economic and Clinical Health Act’s (HITECH) major goal is to increase EHR adoption. The major questions are “Is it enough?” and “Will it work?” Let’s take a look at each of these questions.

Is it enough?Background:
The Health Information Technology for Economic and Clinical Health Act (HITECH) provides $18 million in incentives through Medicare and Medicaid reimbursements. Starting in 2011, physicians who show that they are “meaningfully” using health IT would be eligible for $40,000 to $65,000, and hospitals would be eligible for several million dollars. The incentives would be phased out over time, with penalties in place by 2016.Answer:
$40,000 seems like a large chunk of money for EHR. Of course, we have to remember that it’s spread out over 5 years, but $40k isn’t insignificant. Sure, many EHR out there cost $200k plus to implement. However, not all of them are this expensive. In fact, I’d say that the EHR market has shifted from mostly high priced EHR to more moderately priced EHR with unique pricing structures.

The possible problem with the HITECH legislation is that we still don’t know how HHS will interpret what a certified EHR will be. If they say it’s a CCHIT certified EHR, then $40k might not be enough reimbursement. If they create a better standard for certification which will include specialty EHR and smaller but effective EHR software, then $40k is probably enough for many doctors to turn the corner and implement an EHR.

Will it work?
My simple answer is No.

Let me explain my reasoning. I think we all underestimate the biggest reason why most doctors don’t want to implement an EHR. Many doctors just don’t want to change. Sometimes this is related to fear (see colleagues failures). Sometimes it’s related to retirement pending. Most significant is they just don’t see how it benefits them (the doctor). Throwing a little cash at them isn’t going to change their desire not to change. They’ll just find another excuse. They’re preferred EHR isn’t “certified” might be a good one.

We also have to remember that this isn’t cash up front to pay for the EHR. It comes in the form of Medicare and Medicaid reimbursements that you hope you’ll qualify for after having spent money, time and energy (the oft forgotten element in an EHR implementation) implementing an EHR. If this was cash up front I might have a different point of view. However, far too many doctors have been screwed over (excuse the descriptive language) by Medicare and Medicaid reimbursement. Let’s not be surprised if many doctors don’t believe that they’ll ever see any of this extra Medicare and Medicaid reimbursement. If you still think this is far fetched, just do some research on doctors’ experience getting this same type of reimbursement from the ePrescribing initiative.

Add in the increased “paperwork” otherwise known as reporting requirements to receive the reimbursement and hopefully you’ll have an idea of why I think this won’t work. Most doctors want to see patients. They don’t want to deal with extra paperwork which includes researching an EHR. This is government aid were talking about and that’s pretty much synonymous with red tape.

Conclusion
I’m not trying to be a pessimist, but I am trying to be realistic. I just don’t see this new stimulus package having the desired effect on EHR adoption. More importantly, I hope that doctors take their time in selecting an EHR properly and aren’t swayed by the dollar signs EHR vendors will certainly be waving for them. Another set of poorly selected and implemented EHR will set back EHR adoption for years to come.

Luckily, I’m optimistic that most doctors have seen enough failures around them that they’ll tread lightly and not rush into EHR implementation.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today the following videos came across my Twitter feed and I was interested in video being used to discuss health care IT and in particular the health care IT stimulus package. Props to HealthTechnica for stepping in front of the camera and trying to share some knowledge about health care IT with the world.

The videos are a little long for me. The audio was a little soft too, but not too bad. I would have also liked a short intro of who was at the table speaking. I of course don’t agree with everything they said in these videos and would have liked a little more depth on some subjects, but I do like to point to people doing creative things online with HIT.

The Obama HIT Stimulus Package Video by Health Technica Part 1

The Obama HIT Stimulus Package Video by Health Technica Part 2

Best thing I heard in these videos. “Technology isn’t meant to fix things.” I’ve said this a hundred times when I’ve said, applying an EHR to a poorly run clinic just exposes all the weaknesses of that clinic.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I predict that “meaningful EHR user” will become the most overused term in EHR and Healthcare IT adoption over the next year. Since the term seems to be the cornerstone of receiving a part of the $20 billion EMR stimulus package, then I thought it might be a good idea to understand how HHS might define what a “meaningful EHR user” will need to do.

Luckily Patricia King, a health care attorney in Illinois, posted the criteria for being a meaningful EHR user on NetDoc as follows.

To be a “meaningful EHR user”, the physician must satisfy three criteria:

The physician must use “certified EHR technology” in a meaningful manner, including electronic prescribing. The law calls for creation of a health information technology (HIT) Policy Committee, and an HIT Standards Committee. The HIT Policy Committee will focus on development of a nationwide health information infrastructure, while the HIT Standards Committee will recommend standards, implementation specifications and certification criteria. The Office of the National Coordinator for Health Information Technology (ONCHIT) is to adopt an initial set of standards, implementation specifications and certification criteria before December 31, 2009.

The physician must demonstrate that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.

The physician must submit information on clinical quality measures specified by HHS.

Sound confusing enough? Well, it’s going to be confusing until HHS is able to define what a certified EHR will look like (let’s all hope that it’s not synonymous with CCHIT certification) along with defining how the EHR should be able to exchange information.

I’ll be very interested to watch how HHS plans to implement these things. I wonder if the frenetic pace that President Obama is basically requireing will end up being good or bad for health care IT and EHR adoption.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking a lot about the legislation that’s about to hit the fan in regards to investment in healthcare IT and in particular EHR and EMR softare. My biggest fear in this whole process is that the underlying assumptions being made will turn out to be wrong.

The following is a list of assumptions I’ve seen made in regards to the government’s investment in healthcare IT and EHR and its possible benefits. I’ll also offer a few comments on each assumption for people to consider.

Cost savings – The largest savings I’ve seen a medical practice receive from EHR implementation is in saved transcription costs. There’s some small savings from charting supplies and the like. Otherwise, where are the cost savings occurring? My guess is that if you polled those using an EHR you’d find very few cost savings. You would however find a number of new costs related to investment in technology. There must be some long term cost savings that the government sees that I’m missing.

Cut waste – I guess this has some minimal “Green” benefit. It just seems rather minimal to me.

Reduce the need to repeat expensive medical tests – I can’t wait for this benefit to be realized. Unfortunately, I’m afraid that the technology and more significantly the policies are in place to make this happen. Long term this benefit will be awesome, but we’re so far from realizing it that it’s hard for me to use this as a strong justification for the investment.

Save jobs – Health care has been relatively immune to lost jobs, but this investment will help save some jobs. We’ll just have to see if the money ends up going to big EHR companies who will just get richer in the process or whether this investment will do something significant in regards to saving and creating jobs.

Save lives by reducing the deadly but preventable medical errors that pervade our health care system – I’ve seen far too many research articles on both sides of this argument. Some say it helps prevent medical errors and others suggest that it may cause other errors. I’m not sure which way to think on this. In a perfect world it would certainly prevent medical errors. Unfortunately, a computer can only think so much. I’m afraid that an EHR isn’t the secret elixir we’d all hoped to use to solve medical errors.

I’m sure that I’ve missed other reasons. Feel free to add comments and other reasons I’ve missed in the comments.

I think I better work on a follow up article on the reasons why Obama should invest in health care IT. I think there are good reasons to invest in this area. Otherwise, I wouldn’t be writing about the subject. However, I think it’s interesting and valuable to have a realistic picture of why EHR implementation is important. I really am an EHR and EMR optimist.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the key facets of any EHR investment by the government will look at ways to award money for usage of an EHR. The hard question they’ll try to answer is how do you define an EHR that’s implemented.

This discussion is not new. Every study you can find on EHR implementation has struggled with the idea of defining when an EHR is actually implemented. I think that most surveys I’ve seen usually allow the user to define whether they’re EHR is fully implemented or partially implemented. The problem with this is that each person is likely to define a fully implemented EHR in different ways.

If a researcher has a problem defining an implemented EHR can you imagine how much fun the government will have defining this same thing. Not to mention when you start to attach money to the definition it gets really hairy.

Let me propose a simple definition of a fully implemented EHR using 2 main factors.

1. Paper Charts are no longer created or passed around the office.
2. Patient data can be transferred amongst EHR using a standard such as CCR.

The first factor is easy to measure. Take a look at the paper charts and see how many were created during the past year. Also, look at how a practice handles a patient who already has a paper chart. As long as a practice is relying on a paper chart, they are not full EHR. I should clarify that paper charts can exist in the practice, but they just should only be used for sending out records for past patients.

The second factor is easy to measure, but I’m just a little afraid that the CCR standard is just not quite fully defined. I hope that having Google Health and Microsoft HealthVault will help to establish this standard in an effective way across the industry. Some sort of medium for sharing important information is needed. Even if it’s simply allergies and medications for now would be fine with me. It can always be expanded later.

Should be simple enough. The problem is that it’s probably too simple for government work.

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